Please Note: YOU MUST BE AT LEAST 18 YEARS OF AGE TO FILL OUT THIS APPLICATION. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED!!

* PLEASE MAKE SURE YOU COMPLETE** IF YOU ARE A FIRST TIME PET OWNER OR YOU DON'T HAVE A VET FOR YOUR PRESENT PET, YOU MUST COMPLETE.

*Name Of Pet You Are Interested In

BCAA Contact Person

PERSONAL INFORMATION

*First Name:

*Last Name:

*Address:

*City: *State: *Zip:

*PhoneDay: Evening: Cell:

*E-mail:

FAMILY INFORMATION

List all members of your household and your relationship to them and the ages of all minors.

Name

Relationship to Applicant

Age(if minor)

(If you need more room, please show other household members in the comments section.)

*Is everyone in your home in agreement to adopt this pet Yes No

*Are you aware that there is a set adoption donation Yes No

CURRENT PET INFORMATION

*Do you currently own any dogs? Yes No

Name(s)

Age(s)

Breed(s) & Size(s)

Spayed or Neutered Yes No

If no, give reason why

*Do you currently own any cats? Yes No

Name(s)

Age(s)

Spayed or Neutered Yes No

If no, give reason why

*Did you ever give up a pet Yes No

If yes, give reason why

*Did you ever put a pet in a shelter Yes No

If yes, give reason why

*State the type of Dog or Cat food you use

VET INFORMATION

Vet Name:

Vet Address:

Vet Phone:

Under whose name are the above pets registered with the vet?

HOME INFORMATION

* Own Home Rent Home

Name of Homeowner or Landlord

Address

LandLord Phone Number

Fenced In Yard (Height & Style)

PET INFORMATION

*Will Your New Pet Be A Lifetime Commitment Yes No

If adopting a cat will you declaw the cat Yes No

Where Do You Plan On Keeping Your New Pet

Where Exercised

Home During Day Yes No

Who Is Home

How many hours a day will pet be left alone

JOB INFORMATION

Employer

Employers Address

Name and Phone Number of two Personal References. Please include E-mail Address.

**Personal Reference #1
Name:
Phone:
Email:

Personal Reference #2
Name:
Phone:
Email:

COMMENT

State briefly why you want a pet

By checking the box below I further certify that the information I have provided on this form is true, correct, and accurate.

By checking this box I understand that I'm responsible for all fees incurred by BCAA for bounced checks for the adoption. Also BCAA reserves the right to have the above said animal returned to the Rescue immediately in the event that a check doesn't clear.